Plate Osteosynthesis Technique Research Articles

Positional Screw Effect in the Treatment of Humeral Shaft Fractures Using a Minimally Invasive Plate Osteosynthesis Technique.

This study compares the difference in the clinical and radiologic outcomes when minimally invasive plate osteosynthesis (MIPO) technique is performed with or without using a positional screw in the treatment of humeral shaft fractures. From January 2010 to January 2021, a retrospective study was conducted on a total of 63 patients who underwent the MIPO technique for the treatment of humeral shaft fractures. We divided these patients into 2 groups: in group I, patients underwent MIPO without a positional screw; in group II, patients underwent MIPO with a positional screw. We compared functional outcomes including the American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, Simple Shoulder Test, range of motion before and after surgery, operation time, blood loss, and complications. And we compared radiologic outcomes including pre- and postoperative anteroposterior (AP) and lateral displacement of the fracture and union time on plain radiographs. The average patient age was 64.6 ± 15.1 years (range, 25-88 years). Group I consisted of 30 patients (10 men and 20 women), and group II consisted of 33 patients (11 men and 22 women). Between the 2 groups, there was no statistically significant difference in sex, body mass index, functional scores, AP and lateral displacement of the fracture on postoperative x-ray, operation time, and blood loss. In group II, a faster bony union was obtained than that in group I (4.6 vs. 6.4 months). Complications included 2 cases of transient radial nerve palsy in both groups and metallic failures (2 in group I and 1 in group II). When performing MIPO for humeral shaft fractures, adding a positional screw could be more stabilizing than bridge plating without a positional screw, leading to faster bony union. A positional screw might help control interfragmentary movement without inhibiting essential interfragmentary movement for fracture healing.

Surgical access route and choice of implant in the region of the clavicle shaft

Clavicle fractures are among the most frequent injuries of the shoulder girdle. Nondisplaced fractures are generally treated conservatively, whereas dislocated fractures require surgical reduction and stabilization. A variety of implants and surgical techniques with reliable results are available. While all techniques provide similar healing rates, they share acommon disadvantage with the high incidence of implant irritation and correspondingly high rates of second interventions for material removal. The various surgical techniques for clavicle shaft fractures with their specific areas of application as well as advantages and disadvantages are presented. This review also provides an aid for deciding which surgical technique is most appropriate based on the fracture morphology. Furthermore, an overview of current research activities is presented, with aspecific focus on new implants which could help to reduce implant irritation. Open superior and anteroinferior plate osteosyntheses each show similar reliable results. The minimally invasive plate osteosynthesis (MIPO) technique offers an alternative for multifragmented fractures as it has alower complication rate compared to the open procedure. Double plate osteosynthesis using minifragment plates shows promising results with respect to the incidence of implant-related irritation. Larger prospective studies are still pending. Intramedullary nailing offers agood alternative, especially if material removal is planned anyway, e.g., in the pediatric setting.

A Dilemma in the Management of Distal Tibia Fractures Solved by Minimally Invasive Percutaneous Plate Osteosynthesis Technique: A Prospective Study.

Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.

3D printing assisted MIPO for treatment of complex middle-proximal humeral shaft fractures

BackgroundThis study was designed to explore the clinical efficacy of 3-dimensional (3D) printing assisted minimally invasive percutaneous plate osteosynthesis (MIPO) technique by comparing the clinical outcomes with traditional open reduction and internal plating fixation (ORIF) for treating complex middle-proximal humerus fractures (AO 12C fracture type).Materials and methodsThe data of 42 participants who received a complicated middle-proximal humerus fracture from the beginning of 2018 to the end of 2022 were retrospectively analyzed. All patients were assigned to two groups: MIPO with detailed preoperative planning assisted by 3D printing technique (MIPO group), and traditional ORIF (ORIF group).ResultsThis study included 21 patients in the ORIF group and 21 patients in the MIPO group. All patients were followed-up for at least one year (mean: 16.12 ± 4.13 months), and no difference was observed in the range of shoulder joint motion (ROM), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores and Constant scores between the two groups. However, the occurrence of complications (surgical incision site infection, implant loosening, bone nonunion and radial nerve palsy) in ORIF group was remarkably higher compared to the MIPO group. All the cases achieved bone union within the MIPO group. Significant differences were found in surgical time, intraoperative blood loss and fracture healing time between the two groups.ConclusionPreoperative 3D printing assisted MIPO technique exhibits obvious advantages in high operational efficiency and low occurrence of complications, which is worthy of clinical application for treating complex middle-proximal humeral shaft fractures.

Modified medial minimally invasive double-plating osteosynthesis techniques for the treatment of distal third diaphyseal fracture of humerus

The optimal surgical approach and placement of plates for the treatment of distal third diaphyseal fracture of the humerus are the subjects of debate. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of modified medial minimally invasive plate osteosynthesis (MIPO) techniques using a double technique for the treatment of distal third diaphyseal fracture of the humerus. A total of 30 patients with a distal third diaphyseal fracture of the humerus were selected from our hospital. Patients were seen between January 2017 and October 2022. They were treated with a modified medial approach combined with MIPO using a double plate technique. Patient demographics, operation time, bleeding volume, union time, complications, the mean fracture length (FL) and distal cortical length (DCL), and the number of screws in the distal fragment were analyzed. The function of the shoulder and elbow was evaluated using Neer’s assessment of the shoulder and Mayo’s assessment of the elbow. The FL was 56.1 ± 7.2 mm and the DCL was 38.3 ± 5.3 mm. The mean operative time was 84.8 ± 13.4 min (range 60–110 min). The mean blood loss during surgical treatment was 46.5 ± 10.2 ml (range 30–60 ml). Bone healing was observed in all patients from 10 to 16 weeks (average 12.1 ± 1.7) postoperatively, and one case with poor surgical wound healing was recorded. All the patients had good function of both the shoulder and elbow. The maximum flexibility of the elbow ranged from 130° to 145° (average 138.1 ± 4.8°), with a maximum flexibility straightness ranging from 0° to 5° (average 2.2 ± 1.3°). The Mayo elbow joint function score was 80–100 (average 91.4 ± 5.0). The Neer shoulder joint function score ranged from 85 to 100 (average 92.5 ± 3.9). The modified medial approach was beneficial it did not cause any iatrogenic radial nerve or ulnar nerve injuries. The anterior and the medial side plates are fixed perpendicular to the distal humerus and provide excellent stability at the same time producing better shoulder and elbow joint function.

Expert tibial nail (ETN) versus minimally invasive plate osteosynthesis techniques in the treatment of distal tibia fractures in young adults: A randomized controlled trial

Abstract Purpose To compare anatomical locked plates inserted in a minimally invasive pattern (MIPO) versus expert tibial nailing (ETN) for fixation of extra-articular fractures of the distal tibia in young adults. Patients and methods The study included 120 patients, 84 males and 36 females. The mean follow-up time was 13.5 months, with at least 12 months of follow-up. Cases were equally divided and randomized by the closed-envelope technique into two groups, group A: fixed by anatomical locked plate through a minimally invasive approach, and group B: fixed by ETN. Results The average operative time was significantly higher in the MIPO group (94 min) compared with the ETN group (81.67 mins). Also, the radiological exposure time was also higher (87.6 secs) in group A versus 78.4 in group B. Although there was an incidence of deformity in few cases of the ETN group (eight patients), that was not significant enough to warrant correction by revision surgery. There were no significant differences in the union time (P value: 0.09) and American Orthopedic Foot and Ankle Society (AOFAS) scores (P value: 0.78) between the two groups. Furthermore, the infection and the need for further surgeries did not show significant differences among both groups. Conclusion Both MIPO and ETN are valid treatment options for distal tibia fractures, AO type 43 A. Both methods resulted in acceptable union time, and American Orthopedic Foot and Ankle Society scores, with no reported cases of nonunion. Level of evidence. Therapeutic study, level I

Bridge Plating of Humerus Shaft Fractures by Minimally Invasive Plate Osteosynthesis Technique: A Short-term study

Bridge Plating of Humerus Shaft Fractures by Minimally Invasive Plate Osteosynthesis Technique: A Short-term study

Distal Tibial Fractures – Surgical Outcome Following Minimally Invasive Percutaneous Plate Osteosynthesis

Objectives With preservation of the vascularity of the bone, preservation of the soft tissue envelope and containment of the fracture haematoma, minimally invasive procedures provide fixation in a biologically sound manner. With these in view, this study was conducted to evaluate the technique of surgical management in distal tibial fractures treated by internal fixation with locking compression plate (LCP) and screws through the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Material and Methods In this cohort study, 21 patients with distal tibial fractures who were admitted to the hospital between November 2014 and August 2016 were tracked for at least 10 weeks and up to 39 weeks. Adults who were fit enough for surgery, both male and female, participated in the study. MIPPO procedures were followed for every case. In this investigation, a total of 21 cases were examined. Results 86% of cases with proper bone union were able to bear their full weight at or before the 18-week mark. Complete weight bearing was permitted for the final three patients (14%) at or before 39 weeks. Ninety per cent of patients had fracture union rates that were satisfactory to excellent at 23 weeks. Also, delayed unions were noted in three individuals; two cases experienced ankle stiffness, one as a result of prolonged immobilization and the other as a result of an intra-articular fracture. There were no infections or wound breakdowns during this trial. Conclusion The MIPPO technique with LCP plates is a good choice when intramedullary nailing is inadequate for metaphyseal and distal tibia shaft fractures. Also, early fracture union is easily accomplished using the MIPPO technique and careful application of these plates.

Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures.

This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. The average time to union of all fractures was 12.88weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.

Radiological and functional outcomes of anterior bridge plating with minimally invasive plate osteosynthesis technique for humerus diaphyseal fractures in adults

Background: We conducted a study to evaluate radiological, functional outcomes and complications of internal fixation of humerus diaphyseal fractures by anterior bridge plating (ABP) with minimally invasive plate osteosynthesis technique. Methods: 40 patients with humerus diaphyseal fractures operated by ABP with MIPO between August 2017 and January 2020 were included in the study. All patients were evaluated verbally, clinically, and radiologically for a minimum of 1 year. Results: Mean time to radiological union was 13.75 weeks. Disabilities of the arm, shoulder and hand score improved from a mean of 23.45 to a mean of 5.04 at 6 months. All patients except one had an excellent Mayo Elbow Performance Score score at 6 months. The variation of mean shoulder range of motion between normal and operated side was within 5 degrees at 6 months. Visual Analogue Scale score improved from a preoperative mean of 8 to a postoperative mean of 0.5 at 6 months. Mean intraoperative blood loss was 147 ml. Two patients had a superficial wound infection, one patient had a postoperative radial nerve palsy, and one patient had a delayed union, all of which recovered without any surgical intervention. Conclusions: ABP with MIPO technique for humerus diaphyseal fractures is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior patient satisfaction. Therefore, we recommend that ABP with MIPO should be considered as an alternative treatment option in patients with humerus diaphyseal fractures.

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) for Distal Tibial Metaphyseal Fracture: A Better Option

Objective: The objective of this study was to evaluate the radiological and functional outcomes in of treatment of fracture distal tibial metaphysis fixed with pre-contoured anatomical locking compression plate using minimally invasive percutaneous plate osteosynthesis (MIPO) technique. Methods: This was a prospective study conducted at Department of Orthopedic Surgery, Services Hospital Lahore. Total of 58 closed distal tibial metaphyseal fractures (AO classification 43A) included in the study. All patients were operated using anatomical LCP with MIPO technique. The functional outcome was assessed by Tenny & Wiss criteria at 6 weekly intervals with final scoring at 24th week. Functional outcome was graded as excellent, good, fair and poor. Similarly, radiological outcome was also assessed at 6 week intervals using Hammer et al criteria and grade 3 labelled as union. Results: We observed excellent functional outcome in 48 patients (82.6%) and good outcome in 6(10.34%) at last follow-up. Radiological union was achieved in 100% (58) patients at 24th week. The average time of union was 16.5 weeks with a range of 12 to 23 weeks. Total 03 patients (5.17%) developed superficial wound infection which was successfully managed with antibiotic therapy and no surgical site deep infection reported. Conclusion: Results of this study advocate that treatment of distal tibial metaphyseal fractures with LCP by MIPPO technique is an effective modality resulting in low complication rate, high union rates and good functional outcome.

COMPARISION OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF DISTAL THIRD TIBIA FRACTURE MANAGED WITH IMILN vs. VA-LCP – A RETROSPECTIVE STUDY.

Background: Distal tibia fractures are challenging injuries because of their inherent instability, scarcity of soft tissues, subcutaneous nature and poor vascularity of bone. Although, distal tibial fractures accounts for approximately 7% of all tibial fractures, the best treatment still remains controversial. The purpose of our study is to assess the radiological outcomes of distal third tibia fracture treated with surgical techniques i.e., intramedullary nailing using closed reduction internal xation technique vs. locking compression plating using minimal invasive plate osteosynthesis technique. This Retrospective, observational, hospital-based study wa Method And Materials: s conducted at tertiary health care center KOLAR, involving patients with extra articular closed tibia fractures of distal 1/3 up to 43-A3 of AO classication, from DEC 2016 - DEC2019. Demographic data and clinic-radiological data were collected and evaluated during pre- and post-procedure. Mean union time Result: in intramedullary nailing using closed reduction internal xation technique group was 17.25 ± 1.065weeks and locking compression plating using minimal invasive plate osteosynthesis technique group was 20.19 ± 1.759 weeks, which was statistically signicant with p value less than 0.05. Conclusion: The group receiving the intervention of Locking Compression plating took more time to unite distal third tibia fractures compared to the group receiving the tip locking nailing.

FACTORS AFFECTING FUNCTIONAL OUTCOME OF DISTAL TIBIA FRACTURES TREATED BY PLATING USING MINIMAL INVASIVE PERCUTANEOUS PLATE OSTEOSYNTHESIS TECHNIQUE

Introduction: Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Minimally invasive plating offers the advantage of fracture fixation without disturbing the soft tissue cover, less chances of infection, early mobilization of patient. Using a locking compression plate reduces the tendency for varus collapse and at the same time affords better stability Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them. Clinical and radiological outcomes were studied, and clinical indications & efficacy of the procedure reviewed. Materials and Methods: An ambispective analysis of 30 patients of closed distal tibial fractures were operated by MIPO technique. Bone and soft tissue healing and complications encountered were analyzed. Result: It has been a well-known fact that distal tibia fractures have recently been treated by minimally invasive techniques. Literature above says that there is risk of disrupting blood supply with open reduction internal fixation leading to soft tissue healing problems. However, we did not face any of these complications in our patients, infection or wound breakdown with implant exposure. Conclusion: Distal tibial fractures can successfully be treated by single stage MIPPO plating. Considering a proper surgical timing, respect for soft tissue handling, a good fixation can be achieved. Minimally Invasive Osteosynthesis of distal tibial fracture produced reliable results with acceptable range of movement and resuming early return to activities of daily living.

Effectiveness comparison of two minimally invasive plate osteosynthesis techniques for proximal humeral shaft fractures

To compare the effectiveness of lateral approach minimally invasive plate osteosynthesis (MIPO) and helical plate MIPO in the treatment of proximal humeral shaft fractures. The clinical data of patients with proximal humeral shaft fractures who underwent MIPO via lateral approach (group A, 25 cases) and MIPO with helical plate (group B, 30 cases) between December 2009 and April 2021 were retrospectively analyzed. There was no significant difference in gender, age, injured side, cause of injury, American Orthopaedic Trauma Association (OTA) fracture classification, and time from fracture to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, and complications were compared between two groups. The angular deformity and the fracture healing were evaluated according to anteroposterior and lateral X-ray films postoperatively. The modified University of California Los Angeles (UCLA) score for shoulder and the Mayo Elbow Performance (MEP) score for elbow were analyzed at last follow-up. The operation time in group A was significantly shorter than that in group B ( P<0.05). However, the intraoperative blood loss and fluoroscopy times presented no significant difference between the two groups ( P>0.05). All patients were followed up 12-90 months, with an average of 19.4 months. There was no significant difference in follow-up time between the two groups ( P>0.05). In terms of the quality of postoperative fracture reduction, there were 4 (16.0%) and 11 (36.7%) patients with angulation deformity in group A and group B, respectively, and there was no significant difference in the incidence of angulation deformity ( χ 2=2.936， P=0.087). All fractures achieved bony union, there was no significant difference in fracture healing time between group A and group B ( P>0.05); delayed union occurred in 2 cases and 1 case in group A and group B, respectively (healing time was 30, 42, and 36 weeks after operation, respectively). In group A and group B, 1 patient had superficial infection of incision, respectively; 2 patients and 1 patient had subacromial impact after operation, respectively; and 3 patients in group A had symptoms of radial nerve paralysis of different degrees; all of them were cured after symptomatic treatment. The overall complication incidence of group A (32%) was significantly higher than that of group B (10%) ( χ 2=4.125, P=0.042). At last follow-up, there was no significant difference in the modified UCLA score and MEPs score between the two groups ( P>0.05). Both lateral approach MIPO and helical plate MIPO can achieve satisfied effectiveness in the treatment of proximal humeral shaft fractures. Lateral approach MIPO may be beneficial to shorten the operation time, while the overall complication incidence of helical plate MIPO is lower.

Functional Outcome of Distal Third Tibia Fractures Treated with Minimally Invasive Plate Osteosynthesis

Background: As the highest number of complications are associated with the distal tibia fracture it is one of the most challenging condition to treat. Minimally invasive plate osteosynthesis techniques are more feasible. As the disappointing results were obtained from the traditional techniques therefore this method was gradually evolved. Study design: It is a prospective study conducted in Pakistan Railway General Hospital, Rawalpindi for the duration of one year from January 2022 to December 2022. Material and Methods: The study comprised of 49 patients who fulfilled the inclusion criteria. Among 49 patients there were 23 males and 26 female patients. The patients that were not fulfilling the inclusion criteria were excluded from the study. Results: 40% of the patients had problem in the right leg and 60% had it in their left side. There were 24 patients that reported about fibula plating the remaining 52% had no fibula plating experienced. The mean time of surgery was 7 days ranging from 3 to 8 days. Based on the classification of fracture, 72% patients were included in the 43A category and 43B included 28% patients. Conclusion: For distal tibia fractures, minimally invasive plate osteosynthesis has better radiological and functional outcomes and is quite better than other treatment methods. The invasive method can cure these fractures with fewer complications and in a short union time. Keywords: distal tibia fractures and soft tissue.

Prospective study of radiological and functional outcomes of humeral mid-shaft fractures by anterior bridge plating technique

Background: The humerus can be considered the most versatile bone in the human body. Can be successfully approached by a variety of methods for fracture fixation including functional bracing, plating (posterior, lateral, and anterior), and intramedullary nailing (antegrade and retrograde). Notably, many humeral fractures can be successfully managed conservatively due to the wide range of acceptability for reduction. Anterior bridge plating (ABP) which utilizes the minimally invasive approach popularly known as the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique can be said to be the latest entrant in this list. The present study was undertaken to evaluate the efficacy of ABP. Methods: The study was carried out from July 2020 to July 2022 in DR. D. Y. Patil medical college and hospital, Nerul, Navi Mumbai, involving 32 patients who met the selection criteria and were operated at the tertiary care centre. Informed consent was obtained from all the patients for use of their clinical and imaging data. Ethical committee approval was taken. The assessment of the patients was done based on functional and radiological outcomes periodically. Results: Majority of patients belongs to age group 18-25 years (46.87%). Majority of side of injury were found right side (65.62%). In most of the cases, the extent of the displacement of fractures were 2-5 cm (71.87). Conclusions: In conclusion ABP is a very good technique in treating mid-shaft humeral fractures with minimal soft tissue dissection, smaller scars, and early return to overhead activities.

Minimally invasive percutaneous plate osteosynthesis technique in proximal tibia fractures

Minimally invasive percutaneous plate osteosynthesis technique in proximal tibia fractures

COMBINED PLATE VERSUS EXTERNAL FIXATION FOR DISTAL RADIUS FRACTURES.

This study aimed to compare the functional and radiological results of patients who had intra-articular comminuted distal radius fractures and were operated on with external fixation percutaneous pinning or the volar-dorsal combined plate osteosynthesis. In this study, 49 patients operated on and followed up for the comminuted distal radius fractures between May 2015 and January 2019 were retrospectively evaluated. The surgical outcomes of the patients, who were operated on with combined dorsal-volar plate osteosynthesis or external fixation percutaneous pinning, were compared in this study. Functional and radiological scores were evaluated and analyzed statistically. There was no statistical difference between external fixation and volar-dorsal combined plate groups regarding the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Visual Analog Scale (VAS), the Mayo scoring system, range of motion, and grip strength values. Although the combined volar-dorsal plate osteosynthesis technique had a longer operation time and a more complicated surgical procedure, the combined volar-dorsal plate osteosynthesis had lower complication rates and permitted early mobilization. The combined volar-dorsal plate osteosynthesis could be an alternative to external fixation percutaneous pinning. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

External fixator-assisted plating osteosynthesis in a rabbit model of femoral bone defects appears to be a feasible and reproducible surgical technique: preliminary insights from a bone substitute study

PurposeThe aims of this study were to assess the complications associated with the use of an external fixator-assisted plate osteosynthesis technique to stabilize a femoral bone defect in a rabbit model and to evaluate if this technique could avoid the mispositioning and the displacement of the femoral fragments during the surgical procedure.MethodsA preliminary cadaveric animal study was conducted to develop a new technique of external fixator-assisted plating. Thirty rabbits underwent a surgical procedure consisting in the creation of a femoral bone defect and, subsequently an implantation of a bone substitute through the assistance of a temporary external fixator. The fixator’s ability to maintain length and alignment during surgery was documented. All intraoperative complications were prospectively collected.ResultsNo complications related to the use of the temporary external fixator were reported. The technique successfully prevented mispositioning and dislocation during plating in all the rabbits.ConclusionIn a rabbit animal model, the use of an external fixator-assisted plate osteosynthesis technique appears to be feasible and effective in avoiding misposition and rotation of femoral fragments when performing osteotomy and plating to create a mid-diaphyseal femoral defect.

Is single-stage minimally invasive plate fixation safe in open distal radius fractures with metadiaphyseal involvement?: Retrospective evaluation of 54 patients.

The aim of this study was to evaluate the safety and results of one-stage surgery in Gustilo grade 1 and 2 open distal radius fractures with metadiaphyseal involvement. This retrospective study included 54 patients with AO-2R3 and metadiaphyseal involvement according to the AO fracture classification. All fractures were treated with a long volar plate using the minimally invasive plate osteosynthesis (MIPO) technique. The patients were divided into two groups as open fracture group (25 patients) and closed fracture group (29 patients), and the groups were compared for their union time and complications and functional and radiological results. There was no statistically significant difference between the groups in terms of clinical and radiographic results (P > .05 for both). The mean union time was 12.77 (range, 8-20) weeks in the open fracture group and 12.75 (range, 8-18) weeks in the closed fracture group. There was no statistically significant difference between the groups in terms of union time (P > .05). Moreover, there was no statistically significant difference between the two groups in terms of major and minor complications. All fractures healed without the need for bone and/or soft tissue grafts. As a result of this study, using with long volar plate immediately minimally invasive plate osteosynthesis might be safely used as a single-stage definitive treatment for Gustilo grade 1 and 2 open distal radius fractures with metadiaphyseal involvement. Level IV, Therapeutic Study.